Pneumonia in the elderly

Overview elderly pneumonia often without apparent respiratory symptoms, not the typical symptoms, the disease progress faster and prone to misdiagnosis, wrong consultation. It was reported in the literature, pathological confirmation of pneumonia but failed to clinical diagnosis of "failure rate" of 3.3% -61.4%; and the clinical diagnosis of pneumonia without corresponding pathological findings in the "wrong attendance rate" of 10.8% -39.3%. Cause pathogenesis of the elderly pneumonia common types : (1) aspiration pneumonia. As the elderly larynx mucosal atrophy, thinning and throat feeling receded, pharyngeal constrictor muscle activity is diminishing, have swallowed up obstacles, make food and parasitic in the throat of the bacteria have entered the lower respiratory tract, and cause aspiration pneumonia. Clinical symptoms were not typical, only 34% of high fever and respiratory symptoms without 14% more than 35% of patients with gastrointestinal symptoms, a high rate of misdiagnosis. 20% patients with neuropsychiatric symptoms, low blood pressure, septic shock, cyanosis, weakness, chest pain and rust sputum rare, WBC is not high, prone water, electrolyte imbalance. Chest showed spots or small pieces of shadow. Sputum examination mainly Gram-negative bacilli, a point / 2-1/3, Gram-positive cocci accounted for only 10%. Mixed infection 1 / 3. (2) Gram-negative bacilli pneumonia. Hospital infection pneumonia accounted for 20%, and accounted for nosocomial infections 15% -80% mortality rate of up to 50% and above. The main pathogens Escherichia coli, Proteus mirabilis, Pseudomonas aeruginosa, Klebsiella pneumoniae, and so on. Can be divided into : ① community-acquired pneumonia, the number of primary pneumonia; ② hospital-acquired pneumonia. more ground pharyngeal secretions caused by inhalation (endogenous infection), the promoters of droplets from the air (exogenous infection) rare. (3) mycoplasma pneumonia. Mycoplasma pneumonia and a lung infection in the elderly accounted for 20% of misprision of onset, the clinical expression of irritating cough, irregular fever, headache, chest tightness, nausea; chest X-ray lower inflammation, was patchy spots or shadow, polymorphous, Right over left lung, and a small pleural effusion. Clinical hard with the virus, or slightly different bacterial infections, misdiagnosis rate as high as 55%. Therefore the following circumstances : ① a similar infection in clinical performance, antibiotics (erythromycin, tetracycline except) in the treatment ineffective; ② disease and not commensurate with chest lesions (inflammatory lesions chest Obviously, and symptoms weight); ③ lower lung inflammation and a small pleural effusion, tuberculosis is difficult to interpret. Should make further Mycoplasma serum antibody test, serum specific fixation test (+) 1:40-1:80. Condensation test (+), assist in diagnosis. (4) end-stage pneumonia. Refer patients before dying of pneumonia, and often secondary to other diseases of the late, and the general pneumonia vary, pathological data as much as 30% ~ 60%. Not currently included in the independent disease. Clinical features, early often have no obvious signs, with the patient's condition worsened have the following characteristics : ① not using the original interpretation of the onset of fever or chills; ② dyspnea or cyanosis and the original disproportionate incidence; ③ can not use the primary disease or other reasons to explain the low blood pressure, shock or unconscious increase; ④ sepsis; ⑤ occurred rashes or pus herpes; ⑥ lung breath sounds weakened or disappeared, moist rales postural changes from those changes. (5) The hospital-acquired pneumonia. Refers to the hospital by bacteria, fungi, mycoplasma, viruses or parasites caused by lung inflammation. Among the elderly the incidence was significantly higher in young people, the incidence rate of 0.5% ~ 15%. for various infections within the hospital section 1 -3 times. Main pathogens to see Gram-negative bacilli largest, accounting for 68% -80%, which was also pneumoniae, Pseudomonas aeruginosa, Enterobacter, Klebsiella bacilli common. Gram-positive cocci accounted for 24%, or about 5% of Streptomyces. Clinical manifestations elderly pneumonia include the following clinical features. (1) no more fever, breathlessness and other typical symptoms, the symptoms were only 35%. (2) for the first symptom of breathing and respiratory difficulty accounting for 56%, or a disturbance of consciousness, lethargy, dehydration, anorexia, Asymptomatic persons accounted for 10%. (3) The signs : there will be the pulse rate, fast breathing, chest auscultation can hear and moist rales. or decreased breath sounds associated with bronchial lavage and breath sounds. Check auxiliary : a blood screening : blood leukocytes total number of inspections increased or not, but more than half of the nuclear bits can be seen, C-reactive protein was elevated ESR and other inflammation. 2, arterial blood gas analysis : there will be decreased arterial oxygen, but with chronic obstructive pulmonary disease, alveolar ventilation due to bad carbon dioxide hypertension. 3, chest X-ray showed bronchopneumonia shape than lobar pneumonia see more. 4, elderly pneumonia prone water, electrolyte imbalance, acidosis. Antibiotic treatment of pneumonia in the elderly the choice. 1. Antibiotic choice. 1) identify pathogens before : major consideration Gram-positive bacterial infections, the first choice penicillins or first-generation cephalosporins. Patients with mild available oral antibiotics, such as amoxicillin, usage 0 .25-0.5 once every eight hours of oral. Or penicillin G, 80 million units, 2 / : intravenous drip 2.4 million units -480 10,000 units, 2 / day. Allergic to penicillin were available erythromycin 1 - 2g, 2 times / day, hours intravenous infusion or oral administration of 150 mg roxithromycin. 2 / day. Medium symptoms above, the application of strong antibiotics, such as the second and third generation cephalosporins (Far West) 2 - 4 g / day, two intravenous drip. Ceftriaxone (bacteria must rule) 2g, a time / day infusion. Cephalosporins send one (certainly vanguard) 1 - 2g, 2 / day infusion. Ceftazidime (up to the new Minute) 1 - 2g, 2 / day. 2) pathogens identified : According to the bacteria types and sensitivity of the choice of drugs.